Purpose and scope of this document
AD affects over 5 million Americans today - 340,000 of those individuals are Texans. It is the sixth-leading cause of death in the U.S. and has an economic burden of $226 billion annually. Texas ranks fourth in the number of AD cases and second in the number of AD deaths. A new person develops AD every 67 seconds, and current projections indicate that this rate will increase to one new case every 33 seconds by 2050. In 2014, there were an estimated 15.7 million unpaid caregivers in the U.S., most of whom were family members. In Texas, 1.3 million unpaid caregivers provided care to the 340,000 individuals with AD in 2014. This equates to 1.5 billion hours of unpaid care at a cost of $18.5 billion per year. Alzheimer’s exacts an enormous toll on individuals, families, the healthcare system, and American businesses. It is a serious problem affecting many aspects of our society. Until AD can be prevented or cured, the impact of this disease will only continue to intensify.
Currently there is no treatment available to slow or stop deterioration of brain cells in Alzheimer’s disease. Five drugs are currently approved that temporarily slow worsening symptoms for on average, six to 12 months, and for about half of the individuals who take them. Despite current lack of disease-modifying therapies, studies consistently show that active medical management of Alzheimer’s disease can significantly improve quality of life through all disease stages for individuals and their caregivers. Active management includes appropriate use of available treatment options, effective integration of coexisting conditions into the treatment plan, and use of supportive services such as counseling, activity and support groups, and adult day center programs.
Most older adults—including those with AD —receive their medical care from Primary Care Practitioners (PCPs) (Callahan et al., 2006), who may lack the information and other resources needed to treat this growing and demanding population (Reuben, Roth, Kamberg, & Wenger, 2003). These guidelines were developed specifically for health care professionals in diagnosing and treating individuals with AD, as appropriate medical management and treatment of this disease is imperative. These guidelines were developed to promote best practices for recognizing, diagnosing, and providing treatment to individuals with Alzheimer’s disease or a related dementia. These guidelines are broad enough in scope that they can be used by primary healthcare professionals, including physicians, nurse practitioners, physician assistants, social workers, nurses, and other professionals providing primary care to patients with Alzheimer’s and their families. Recommendations for management of associated neuropsychiatric symptoms and coexisting medical conditions often seen in persons with Alzheimer’s disease are included in these guidelines. Patients with Alzheimer’s disease often need concomitant medication for treatment of diverse central nervous system disorders associated with progressive brain dysfunction (Cacabelos). Suggestions for easily administered and scored appraisal tools are incorporated when possible, as well as diagnostic and treatment pearls.
These guidelines also present best practices on the diagnosis and treatment of mild cognitive impairment (MCI), which can affect memory and other cognitive areas, but much less severe than Alzheimer’s or other dementias. Information on the relationship between MCI and Alzheimer’s disease is also presented.
These guidelines were developed and peer-reviewed by a group of Alzheimer’s disease experts working to meet the Disease Management objectives of the 2010-2015 Texas State Plan on Alzheimer’s Disease. These groups include the Texas Council on Alzheimer’s Disease and Related Disorders, the Alzheimer’s Disease Program at the Texas Department of State Health Services, and many dedicated volunteers of the Texas Alzheimer’s Disease Partnership.
Ultimately, it is our hope that these guidelines will help improve the quality of life of those individuals living with this disease, and those who provide care to them.
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